Keys To SuccessStephen Taplin MD, MPH

Deputy Associate Director, Healthcare Delivery Research Program

Division of Cancer Control & Population Sciences, NCI

April 21, 2023

2

You miss 100% of the shots you don’t attempt

Wayne Gretzky

3

This is the beginning •We listened•We Talked•We planned And now we go home and continue

Screening implementation is a multilevel Problem

State

National

Improved Quality of Cancer Care

Improved Cancer-Related Health Outcomes

Community

PracticeSetting

Provider/Team

Family & Social Supports

IndividualPatient

Family / Social SupportsFamily dynamicsFriends, network support

Individual PatientBiological factorsSocio-demographicsInsurance coverageRisk statusCo-morbiditiesKnowledge, attitudes, beliefsDecision-making preferencesPsychological reaction/coping

Provider / TeamKnowledge, communication skillsPerceived barriers, norms, test efficacyCultural competencyStaffing mix & turnoverRole definitionTeamwork

Local CommunityCommunity Level Resources Medical care offerings Population SES Lay support networks Private cancer organizationsLocal Hospital & Cancer Services Market Level of competition Managed care penetration Percent non-profit Specialty mixLocal Professional Norms MD practice organizations Use of guidelines Practice patterns

National Policy – Affordable Care Act Structure Culture

StatePolicy reimbursement of clinical trials

Stucture

Culture advocacy groups attitued/expectations

Organization / Practice SettingLeadershipOrganizational structure, policies & incentivesDelivery system designClinical decision supportClinical information systemsPatient education & navigation

Taplin & Zapka – JNCI 2010

-- We have to think about all the levels

5

Key #1: You are not alone

State Cancer Control Plans

For example

State X – 20% decrease in late-stage disease among African Americans, Asian & Pacific Islanders

by ….2015

Increase affordable & timely Dx colonoscopy and Rx

Education, promotion, advocacy

Primary Care Associations

Technical Assistance

Resources (QI experience, data & reports, grant opportunities)

Federally Qualified Health Centers

Populations at risk, UDS reporting

The People we want to affect!

6

Key # 2

This CRC effort is not a unique process

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Act Plan

Study Do

A. Who?1. Leadership

a. Stateb. Organizationc. Medical team

2. Who else?a. Advisory board?

B. What?1. Multiple activities2. Evidence-based options

a. communicationb. activities in practice

3. Measurement and feedbackC. How?

1. Make a plan2. Assemble a team3. Get Patients screened4. Coordinate

7

Key # 3: Build on what you’ve learned and gathered here!1) Complete the plans

Leadership support? Recruit other centers?

Credible data and baseline assessment?

2) Build the team Establish coalitions Recruit gastroenterologists Clarify capabilities, roles, responsibilities within state

Clarify capabilities, roles responsibilities within participating centers

3) Offer patients screening

Systematize the offer

4) Coordinate Care across the screening process Monitor Progress –measurement & feedback

8

Key #4: Learn from your failures and your successes Plan/Do/Study/Act cycles

We learn from everything if we pay attention How was the plan received?

A means for improvement?

Who resisted the work and why? Change in emphasis? Clarify roles further? Find /offer data?

Where did the systemization break down? At the outset? When roles got foggy?

Was coordination successful? Adequate data available? Did you seek IT support

9

Key # 5: Persist

Screening Measures can be rewarding

….or discouraging

Get more data

Tu et al – Adaptive reserve matters – 4/15/2015

FQHC survey and evaluation of CRC implementation

Corley et al - Adenoma Detection Rate

Effect of single DRE?

Role of Cancer Centers?

Get more help

Plan for consultation and reconvening of the team

Adjust (Act)

10

It takes a village…

American Cancer Society

Durado Brooks, MD, MPH

Randy Schwartz, MSPH

Lorrie Graaf, RN

Sarah Shafir, MPH

Todd Tyler, BS

National Cancer Institute

Stephen Taplin, MD, MPH

Cindy Vinson, PhD, MPA

Veronica Chollette, RN, MS

National Association of County and City Officials

Brandie Adams, MPH

Centers for Disease Control and Prevention Nikki Hayes, MPHEna Wanliss, MSAngela Moore, MPHAnne Major, BAFaye Wong, MPH

Health Resources and Services Administration Laura Makaroff, DO

National Colorectal Cancer RoundtableMary Doroshenk, MA

Project ConsultantKerstin Ohlander, MS

11

Thank you

References:1.Taplin et al Implementing Colorectal Cancer Screening in Community Health Centers. Medical Care 2008

2.Sarfaty et al Strategies for Expanding Colorectal Cancer Screening at Community Health Centers. CA CANCER J CLIN 2013;63:221–23

www.cancer.gov www.cancer.gov/espanol

References:1.Taplin et al Implementing Colorectal Cancer Screening in Community Health Centers. Medical Care 2008

2. Sarfaty et al Strategies for Expanding Colorectal Cancer Screening at Community Health Centers. CA CANCER J CLIN 2013;63:221–23